Provider Demographics
NPI:1275154221
Name:STICKS ON THE GO LLC
Entity Type:Organization
Organization Name:STICKS ON THE GO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:SHAKESHIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARRIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-300-2090
Mailing Address - Street 1:242 S WASHINGTON BLVD # 293
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4910 26TH ST E APT 202
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4945
Practice Address - Country:US
Practice Address - Phone:941-300-2090
Practice Address - Fax:786-441-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service